Primary adrenal angiosarcoma: A case report and review of the literature

Fig. 1. MRI Axial T2 (A) imaging shows a 1.9 cm right adrenal ovoid mass with heterogenous T2 signal. Post-contrast axial region of interest images shows rim enhancement (B). Follow-up MRI Axial T2 (C) imaging obtained 9 months later show significant increase in size of the right adrenal mass compared to prior study, now measuring 4.3 cm consisting of predominantly T2 hyperintense signal with hypointense septations. Diffusion weighted imaging (D) shows diffusion restriction. Dynamic post-contrast T1 image obtained at 6 minutes (C) shows progressive enhancement of the mass with non-enhancing internal component. In and out of phase images (not pictured) showed no significant signal drop-out comparing out of phase to in phase, confirming a lack of intralesional fat.

Fig. 2. Gross examination of the adrenal gland shows a 4 cm tan-brown and hemorrhagic and cystic lesion. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3. Adjacent to adrenal cortex, there is hemorrhagic and cystic lesion (A, magnification, 54×) with irregularly shaped anastomosing vascular channels lined by mild to severe atypical endothelial cells showing multinucleated, hyperchromatic and pleomorphic features (B–D) with atypical mitosis (D). (B-D, magnification, 200×). Immunohistochemical stain shows that the tumor cells are positive for endothelial cell markers ERG (E), CD31 (F, lower magnification, inset.), and FLi-1 (G) (magnification, 44×). Ki-67 shows approximately 10% proliferative activity (magnification, 200×).